Disruption to cancer services across Europe due to the COVID-19 pandemic will continue, even as the number of infections decreases, without a coordinated effort to guarantee access to care, warns an expert from the European Society for Medical Oncology (ESMO).
While the reduction in the number of COVID infections means hospitals are beginning to resume cancer services, the fallout from the pandemic will continue, said Dr Rosa Giuliani, director of public policy at ESMO, due to the "inevitable" economic fallout.
UK Backlog
As reported by Medscape News UK, the COVID-19 pandemic has caused enormous disruption to cancer services in the UK.
Leading charity Cancer Research UK calculated that around 2.4 million people across the country have been left waiting for cancer screening, further tests or cancer treatment, with tens of thousands of cases left undiagnosed.
This scenario has played out around the world, with cancer services hard hit, alongside those for other non-communicable diseases (NCDs), as a result of the pandemic.
A report published by the World Health Organisation on 1st June indicated that 42% of 155 countries surveyed have seen cancer services partially or completely disrupted, rising to 54% in countries where the COVID-19 virus has taken hold in the general community.
'Huge Disruption'
To find out more about the situation across Europe and what is being done to re-establish cancer services, Medscape News UK spoke to Dr Giuliani, who is also a consultant in medical oncology at the Christie Foundation Trust in Manchester.
She said that, while it is hard to obtain "exact figures" for Europe as a whole, she believes that the numbers reported in the UK will have been repeated throughout the continent.
"There was huge disruption and a dramatic reduction" in referrals for screening services in countries such as the UK, France, Italy, and Germany, she said, as well as in treatment and palliative care, "so I think the figure we are talking about...is in the millions" in each country.
It is "an important figure and it's quite scary" and adds up, across Europe as a whole, to the "billions".
Dr Giuliani emphasised that, while every country addressed the issue "in a different way", the disruption to cancer services was the result of "trying to protect" its citizens.
The idea was to stop "whatever was not strictly necessary", whether that was screening or treatment lines that were "not necessarily associated with an evident overall survival gain from clinical trials but that nevertheless we used to administer to patients".
This was also seen with cancer surgery, where the number of procedures performed reduced substantially.
"There were levels of priority defined and so, whenever possible, surgeries and treatment were basically deferred", she said, as the risk associated with contracting COVID-19 was perceived as higher than the benefit from the specific intervention.
Resuming Services
"Of course, I'm biased," Dr Giuliani continued, "but I'm quite proud of how the NHS and the health systems across Europe reacted to this problem.
"We tried to keep the very essential treatment ongoing and to have long conversations with patients...trying to explain why we were trying to protect them in giving, or not giving, a specific treatment."
She added: "Despite that, we now need to understand how to resume a sort-of 'normal rate' of activities and protect the citizens and patients who want access to the services they need."
Just as COVID-19 took hold in Italy before the rest of the continent, Dr Giuliani said that cancer services have restarted there, now the situation has started to improve.
"It was clear, for instance, that it was very important" to start screening again and for patients to have access to hospital and treatment centres, she said, with the goal of protecting "as many as possible from the infection but at the same time not delaying treatment".
This means restricting access only to patients themselves and screening for raised temperature, among other measures, which, until a vaccine for COVID-19 becomes available, will remain in place for the foreseeable future.
Flexibility
Despite these difficulties, Dr Giuliani nevertheless believes that good things have come out of the COVID-19 pandemic.
For example, she said that all across Europe hospitals performed virtual consultations over the phone or via the internet, which were "appreciated" by the patients.
This, she underlined, has shown it is important to "think twice" before restarting services or activities "until it is essential to do so".
"The COVID story told us that there can be a very important crisis at any time," with substantial disruption to services, "and we need to be prepared to react to that."
However, Dr Giuliani emphasised that "we need to be flexible, because the behaviour that we adopted during the acute crisis is not necessarily the best at times when the rate of infection is decreasing".
She added that, "cancer services should proceed in ways that they can adapt to the situation".
This needs to include ensuring that patients feel comfortable about receiving screening or treatment.
"At the very beginning it was very difficult to explain to patients not to come to the hospital," she said, "because it would have been quite dangerous for them...before we realised that we had to have different separate pathways for patients with different types of problems.
"Now, the difficult part, I heard from some colleagues, is to convince patients that they can have access and they are safe coming to the hospital."
Economic Crisis
Having lived through the acute phase of the pandemic and having now begun to restart cancer services, Dr Giuliani said the next phase will be to react to the economic crisis that will "inevitably follow".
"We don't want that to affect the access of patients to cancer screening, treatment, medicine, palliative care, and so on."
She added: "It's very important to be prepared for that phase as well. We want people to have access to essential treatment."
For her, that means coordination of cancer services on a European, or even global, level.
"What we've seen during the first phase in every country of the outbreak of the coronavirus is...every centre tried to collect data," both at the local hospital and national level, Dr Giuliani said.
Consequently, there are "many databases and this is totally understandable; everybody is trying to collect information to understand what's going on and how to react to this new situation".
"But I think it's really time to have some sort of more global coordination, certainly at the European level but even more a worldwide level."
To those ends, ESMO supports the World Health Organisation's COVID-19 Response Resolution to tackle the challenges faced by people with health conditions due to service disruption, lack of sufficient resources, and patient travel restrictions.
Moreover, the society has launched its own recommendations for cancer management during the COVID-19 pandemic aimed at oncology professionals, as well as a guide for cancer patients.
No funding declared.
No conflicts of interest declared.
